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Optimal levothyroxine dose in post-total thyroidectomy patients: a prediction model for initial dose titration

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Abstract

Purpose

As the lack of consensus in the initial levothyroxine (LT4) dose titration following total thyroidectomy exists, the aim of this study was to identify and quantify predictive factors for LT4 dose replacement.

Methods

A retrospective analysis of a prospectively gathered data of 234 patients who underwent total-thyroidectomy at two institutions between November 9, 2009 and January 1, 2016 was conducted. Outcome variable was the clinically observed optimal LT4 dose. Linear and polynomial regression methods were used for prediction. Continuous variables were tested for mean differences using Student’s t-test and association using Pearson’s correlation.

Results

We identified Body Surface Area (BSA) as the most significant predictor. We propose a model that titrates LT4 dose based on BSA (1.4 µg /kg/day for BSA > 1.79 m2 vs. 1.7 µg /kg/day for BSA ≤ 1.79 m2; P = 0.00). Men required higher doses than women and no differences were noted based on DM status or pathological diagnosis.

Conclusions

Our analysis shows BSA as an independent predictor of LT4 dose post total thyroidectomy. Despite the possibility of generating different equations for predicting LT4 post total-thyroidectomy, finding a practical and clinically relevant prediction model is yet of limited efficiency.

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Authors and Affiliations

  1. Department of Otolaryngology — Head and Neck Surgery, College of Medicine, King Saud University, King Abdul Aziz Rd, AlMalaz, Riyadh, 12629, Saudi Arabia

    Saleh F. Al-Dhahri, Samiah S. Al-Angari & Mohammed AlEssa

  2. Department of Otolaryngology — Head and Neck Surgery, King Fahad Medical City, Riyadh, Saudi Arabia

    Saleh F. Al-Dhahri

  3. Department of Otolaryngology — Head and Neck Surgery, Majmaah University, Al Majmaah, Saudi Arabia

    Jabir Alharbi

Authors
  1. Saleh F. Al-Dhahri
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  2. Samiah S. Al-Angari
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  3. Jabir Alharbi
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  4. Mohammed AlEssa
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Corresponding author

Correspondence to Samiah S. Al-Angari.

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Research involving human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (KFMC-IRB approval #18–245) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Al-Dhahri, S.F., Al-Angari, S.S., Alharbi, J. et al. Optimal levothyroxine dose in post-total thyroidectomy patients: a prediction model for initial dose titration. Eur Arch Otorhinolaryngol 276, 2559–2564 (2019). https://doi.org/10.1007/s00405-019-05523-4

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  • DOI: https://doi.org/10.1007/s00405-019-05523-4

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